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Protesters outside Cottage Hospital on Monday morning held their babies along with their signs. Objecting to area obstetricians’ choice to prohibit natural childbirth procedures for women who have had a cesarean section, or Vaginal Birth After Cesarean (VBAC), most of the women and men aimed to inform passersby of their plight and to ultimately grant expectant mothers the choice to deliver their babies naturally regardless of previous birthing procedures they may have undergone. It’s been four years since Santa Barbara obstetricians began following this guideline.

Amara Maliszewski explained that for many women, it is devastating news “when someone tells you [that] you can never experience this awesome natural miracle.” Maliszewski said she felt lucky to have delivered her “VBAC baby,” Lucinda, at home with a midwife. She also said that many doctors do not recommend women to have more than two or three cesareans in their lifetime; and with American College of Obstetricians and Gynecologists’ (ACOG) recommendation to obstetricians to deliver babies via cesarean sections, women are consequently limited as to the amount of children they are able to have, protestors said. “This is a civil rights issue to birth your child the way that you want,” said Adela Barcia, a psychotherapist specializing in prenatal and perinatal health and psychology. Barcia has experience with the evidence that the method of birth affects the psychological and physical health of the baby and mother and said she works with “many women who have profound grief about the issue.”

Catherine Meagher

Protestor Carrie Bluth and her child

Doctors told Abraham and Jessica Powell that she had a .5 percent of a chance of uterine rupture after VBAC. Uterine rupture is the most commonly cited risk with VBAC, when the uterus tears during delivery, requiring the delivery to be switched to a cesarean. According to ACOG, the switch causes an increased risk of infection to both the baby and mother. “Finally, what it comes down to is a question of choice,” said Jessica Powell. After she went into labor, she had to drive to UCLA where VBAC is standard procedure. “It seems crazy and it is.”

Indeed, driving to UCLA as the Powells did seems to be one of the options for women wanting to birth their children vaginally. But the requisite multiple prenatal checkups in Los Angeles, not to mention the two-hour drive while in labor, some may call this “completely impractical” and “nearly impossible.” Even so, the Powells decided this was the best way for their family, and they are glad they did so. Their second child was born with no complications.

Protestor Carrie Bluth explained that she found an obstetrician at Ventura Community Memorial who was very sympathetic towards her. When asked how she delivered VBAC, she answered simply, “I asserted my rights.” She refused to have the surgery when she arrived at the hospital late in her labor, and immediately said she did not want a cesarean.

Although the widely-accepted terms for this debate are “ban” and “hospital policy,” Janet O’Neill, Cottage Hospital Spokesperson and Director of Public Affairs, explained that this decision is absolutely independent of Cottage Hospital’s standard guidelines, however. She says this decision was made after a recommendation from the ACOG to the doctors in Obstetrics & Gynecology.

Dr. Robert Reid, MD, Director of Medical Affairs at Santa Barbara Cottage Hospital, emphasized the need for a standard of procedure at Cottage when it comes to this debate. He said he recognized the reason for ACOG’s recommendation and understands the safety and liability issues. In order for VBAC to be safe, an emergency surgical staff needs to be immediately available; this is why larger teaching medical centers such as UCLA and Sierra Vista in San Luis Obispo offer VBACs while Santa Barbara facilities do not.

Jessica Barton, the organizer of the protest, said she hopes that obstetricians in Santa Barbara will be practicing VBAC again soon. Barton continued that it doesn’t matter if the hospital calls it a ban or policy. “Women are experiencing a lack of access to VBAC in our community,” she said, noting that a big challenge for new mothers after having a cesarean is the extensive recovery period. After her own cesarean, Barton says the first few days she was hardly able to pick up her new baby, which made it difficult to breastfeed. “It was 12 weeks before I felt like my real self again,” she says; it’s for this reason that she is fighting for the option of VBAC rather than going through major surgery again.

Currently, Barton and her fellow protesters from Birth Action Coalition are working to raise awareness in the community; they are also writing letters and pressuring the hospital to allow VBACs once again. Another rally is planned to take place in Ventura.

Comments

As long as the doctor doesn't do anything stupid. Are doctors who do any type of delivery clear to be neglectful or push harmful, unnecessary interventions on birthing women?Women who choose VBAC are very aware and educated about why they want VBAC. They will know if the doctor has their and their baby's best interest in mind if an attempted VBAC fails and repeat cesarean is necessary.

The bottom line is that VBAC is a safe option for many women and the OBGYNs at Cottage are denying women this choice. It makes Cottage, it's board and OBGYNs look like they have limited interests and narrow-minded views.

Both the Doctors and Cottage Hospital must be reminded of their duty to gain informed consent for ALL procedures. This means that a woman who is agreeing to Cesarean, must be made aware of all of the risks associated with this surgery, and she must understand that it is major abdominal surgery. Unless she is properly informed, she has not given true consent.

And the Doctors & Hospital must be reminded about every patients right to refusal of treatment. Anyone can refuse any type of medical treatment, including a repeat cesarean.

I personally believe that by denying women access to VBAC when they want it, and thereby forcing them to have surgery, the Hospital, or Docs, or whoever is trully responsible for denying women access to this option, is committing battery against women.

Whether the environment is hostile to Docs who allow VBACs, or the Hospital does not allow it, or Docs are choosing not to offer it, make no mistake: There IS a VBAC Ban at Cottage!

and Docs & Hospital have medical malpractice insurance already, they do not need any indemnification from or through their patients.

So you're saying the patient, not the doctor, is the expert on medical procedure risk? And if the doctor believes that a VBAC is ill-advised, and the patient insists on it anyway, and the doctor agrees against his/her better judgement, then if something goes wrong all of those who pay already ridiculously high malpractice premiums are penalized? C'mon.

So are you saying decisions in medicine should be based on litigation fears, rather than what is best for patients?

Many doctors, including several in Santa Barbara, believe that VBAC is a safe option. Scientific studies (abstracts available on the ACOG website) show that VBAC is a reasonable and safe option for many women. The fact that the UK encourages VBACs and the Netherlands doesn't allow elective repeat cesareans for women with one cesarean attests to the safety of VBAC. And just a technicality, VBAC is not a procedure.

If patients have open discussions with their physicians about risks and benefits and feel they are making the best decision they can, they would be less likely to sue.

In any case, regardless of risk, any patient should have the right to refuse any procedure. This is a human rights issue.

I agree that the malpractice climate in this country is a mess and if doctors didn't have to fear law suits they might be able to practice differently. I understand that there are efforts underway to reform this and I whole-heartedly support them.

Sorry, it wasn't clear to me that the issue was that the patient wouldn't be allowed to refuse a procedure. I thought the issue was that the patient wanted VBAC while the M.D. thought it ill-advised. The patient is always free to find an agreeable M.D., no? And to your point, as one coming from a family of M.D.'s, I believe medicine should be practiced on the basis of what is best for patients, acting with informed consent after consultation with their doctors. But one cannot deny the risk environment, the facts that the medical community, and especially insurance companies, are typically seen as deep-pocketed, that juries are notoriously generous with awards in medical suits, and that hospitals must be keenly aware of malpractice risk (not only risk to their financial situation but even more importantly to their reputation). Yes, the malpractice climate must be changed. But in the meanwhile remember two important words: "litigious society". Hence, my original question - if the patient wants to countervene her doctor's recommendation, should she not indemnify the doctor (or find another)?

Yes RC, a patient should absolutely find a doctor that supports her choices in birth. And, she needs to take responsibility for her choices... but when she doesn't have a choice... what can she do?

and No, a patient should not ever have to indemnify her doctor. Each Doctor can always refuse to take on a patient and refer her to another Doctor, if they feel the risk is too great to "treat" a woman as she chooses. And FYI: there are many Doctors in Santa Barbara, in the Country and around the world who view VBAC as THE safest and best option for most women who have had a previous cesarean.But, as we have seen in Santa Barbara, the environment at the Hospital does not permit Doctors to admit patients who want to try to birth their baby vaginally after a cesarean.

Part of the "Choices in Childbirth" movement, is to empower women to take ownership of their pregnancy, birth and their overall healthcare (shouldn't everyone!).When women know that they do have options, and don't have to blindly follow the "instructions" of their Doctor, and thus totally rely on the Doctor to make decisions for them ... , they may tend to not "blame" the Doctor when something does not proceed perfectly.

I totally agree that we live in a litigious society, and I don't like how patients expect their Doctors to be all knowing and never make mistakes. I do not expect my Doctors to be perfect, but I do expect them to give me their best advice, and then let me make the decision.

I also believe that if OB's began to look at the actual evidence based data, and treat pregnancy and birth, not as a medical procedure to be managed, but as a normal and natural event, and each woman and pregnancy was seen as unique (no one size fits all aproach) and if they began to be outspoken in their support for the work that Midwives and Doulas do...then OB's would see women who trully felt supported in THEIR decisions related to birth, that even when things did not go perfectly, the Doctor would not be held up on a pedestal of perfection.

I would like to see cottage hospital engage in some creative thinking about this important issue rather than just hiding behind the plea of liability. Clearly there is more at stake for women and babies who receive the surgery than for the people administering it. When everyone tries to find a solution to a problem, there usually is a successful solution that comes to the surface. I would love to hear some real human dialog about this. Can and does the hospital administration acknowledge what it must feel like for a woman to be facing an unwanted and potentially dangerous surgery that usually causes immediate separation from her infant, interrupting possibly the most formative moment of her infants life, as well as leaving her disabled during the challenging time of early infancy, with the added challenge of having another young child at home needing her care as well? A cesarean is much more than a surgery in the life of a young mother. It is a set back to her mothering capabilities at a formative time for her whole family. I think the hospital administration has forgotten to take the human element into consideration. What are the real statistics on VBAC as compared to second or third cesarean risks?

Doctors should be telling women the truth, that C-sections put the mother at 4 times the risk of death as compared to a vaginal birth, and allowing women to choose which set of risks they want to take. It's not just about the baby when you're deciding VBAC or repeat C-section. A woman who is having to make this decision has at least one other child at home who faces the possibility not just of losing a sibling, but of losing a mother as well. For the doctor, it's simple--a 20 minute procedure, in and out, as opposed to attending a potentially long labor, and once it's over, he or she doesn't have to think about it any more. For the woman, she has to recover from major surgery while caring for a newborn and additional children. She has another scar on her uterus that increases the chance of placenta accreta and other problems in subsequent pregnancies. She faces an increased chance of death or major complications, including pelvic pain that can last for months, and for many, that pain never goes away. These are things that doctors rarely mention to women, they merely cite the risk of rupture (1 in 200, which is equal to the risk of miscarriage caused by amniocentesis, and yet the doctors don't "ban" those or have "policies" against them) and recommend a C-section instead. They never mention they are concerned about the risk of a lawsuit and that this is their primary motivation for recommending a C-section. Juries rarely find against a doctor who performed a C-section, they usually will find against the doctor who didn't perform a C-section.

I think it is interesting that the medical director's wording seems to contradict the cottage hospital website.

"Dr. Robert Reid, MD, Director of Medical Affairs at Santa Barbara Cottage Hospital, emphasized the need for a standard of procedure at Cottage .... In order for VBAC to be safe, an emergency surgical staff needs to be immediately available; this is why larger teaching medical centers such as UCLA and Sierra Vista in San Luis Obispo offer VBACs while Santa Barbara facilities do not. "

They also say that they are the only trauma center between LA and San Jose where the above article mentions SLO doing VBACs. So our trauma center is better than SLO but SLO is doing VBACs? This doesn't make sense!

In my opinion, the hospital is prepared to cut me open should I have a heart attack but not to assist me with birthing my children naturally and safely if I have had a prior C-section.

If I have had prior open heart surgery and present with chest pains, do you open me up automatically or decide what is the best treatment option for my situation before cutting me open?

This is ridiculous, yes, but if I want to expand my family past 3 kids or find myself unexpectedly pregnant with a fourth, this decision puts my future health and the health of my future children at risk. This makes me as mad as tailgators do!!!!!! Sorry for the rant but I am mad as hel* and I'm not going to take it any more.

I would prefer not to show up at the hospital to have my baby and sour the whole experience by having to refuse a c-section in order to do what I feel is safest for my baby and for me. I would prefer to have an honest conversation with my doctor about it without the feelings of mistrust I have now.

Our health care team is dedicated to making the birthing experience a safe, joyous and memorable occasion for you, your newborn and your family. The Birthing Center gives you a choice of birth methods and encourages family members to be present during birth. Birthing rooms are tastefully decorated and there's even a family room for family members who want to share in this happy event."

Wow, a choice of birth methods...as long as that choice is a C-section for over 30% of us. Sigh.

Anyhow, I do hope you will visit the birthactioncoalition website and consider writing a letter! Best of luck in your quest for a VBAC!!